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About half of people subject to CCTO unhappy with them, research finds

04 January 2016

About half of people who are subject to a community-based compulsory treatment order (CCTO) are unhappy with it, according to research by the Mental Welfare Commission.

The Commission, which reviewed the care and treatment of 101 people subject to a CCTO including interviewing 88 people for its report, found that half of interviewees were unhappy with the order, either because of the medication they had to take, or the care and support they had to accept. In addition, no-one was in full-time employment and only 8 of those interviewed were in part-time work.

In contrast, about half the people the Commission met felt that the CCTO was of some benefit to them, though very few knew how or when the order could be revoked.

CCTOs were introduced in 2005, when Scotland began using new mental health laws that allowed community-based compulsory treatment for people who are unwell, but who are unable or unwilling to agree to treatment. Now, such treatment in the community makes up more than 40% of all compulsory mental health treatment in Scotland.

Pre-2005, most people who were given compulsory treatment were treated in hospital. The law did allow some people a leave of absence from hospital, which could run for a maximum of a year. But CCTOs do not have that time limit, and there have been concerns that people are maintained on these orders for longer than is necessary.

Other findings in the Commission’s report included that only a small number of eligible people had physical health screenings. These are important for people with long-term mental ill health, as their physical health is often worse than that of the general population. Fewer than half had documented regular physical health monitoring.

More positively, most 'named persons' felt appreciated and involved with the professional care and support being given to their relative or friend and very few people had any negative comments about their accommodation. Likewise, care plans were said to be mostly good; focused on recovery, and addressing the needs of the individual.

The report also made a number of recommendations, including that services should ensure there is clear evidence of reviews, and a revocation strategy, in the case notes. The revocation strategy should be shared with the patient.

In addition, local authorities should identify how they can more effectively comply with their legal duty to support people subject to CCTOs to secure and sustain employment. They should also work with the Scottish Government to consider new opportunities to support this group.

There were also recommendations for services; they should promote the use of advance statements, and individual practitioners should discuss the use of advance statements at regular intervals, e.g., at review meetings. Services should also ensure patients participate at review meetings when their case is being discussed, unless they do not wish to attend.

Finally, patients should have physical health checks every 15 months, and access to relevant screening programmes.

Dr Gary Morrison, executive director (medical) at the Mental Welfare Commission, said: “While there are certainly many positives in being able to treat people in the community, rather than in hospital, there are also challenges.

“We were particularly disappointed to see very little evidence of revocation strategies. People need to know when an order might end, and health and social services staff need to plan ahead for that, in discussion with patients.

“It is also disappointing to see that not one of the 88 people we interviewed had a full-time job, and only eight had part-time work. We need to understand better why this is – whether it is because people are too unwell to work, or whether stigma about mental illness is preventing people from getting that opportunity.”